High Infection Rates Seen in Juvenile Idiopathic Arthritis

Oral glucocoticoids, but not methotrexate or TNF inhibitor use linked to increased infection

WEDNESDAY, May 9 (HealthDay News) -- Children with juvenile idiopathic arthritis (JIA) have higher rates of hospitalized bacterial infection than children without the condition, and high-dose steroids significantly increase the rate of infection, according to a study published online May 8 in Arthritis & Rheumatism.

Timothy Beukelman, M.D., from the University of Alabama at Birmingham, and colleagues utilized national U.S. Medicaid data from 2000 to 2005 to identify a JIA cohort (comprising 8,479 patients) and a comparison cohort of children with attention-deficit/hyperactivity disorder (ADHD). Use of methotrexate (MTX), tumor necrosis factor alpha (TNF) inhibitors, and oral glucocorticoids was established from pharmacy claims data, and hospitalized bacterial infections were identified using discharge codes.

The researchers found that, of the JIA patients, 42 percent used MTX and 17 percent used TNF inhibitors. JIA patients not currently using MTX or TNF inhibitors had an increased rate of infection compared with children with ADHD (adjusted hazard ratio [aHR], 2.0). JIA patients using only MTX had a similar rate of infection compared with those not currently using MTX (aHR, 1.2; 95 percent confidence interval [CI], 0.9 to 1.7). Patients using TNF inhibitors had a similar rate of infection to those using only MTX, irrespective of their MTX use (aHR, 1.2; 95 percent CI, 0.8 to 1.8). Compared with not using glucocorticoids, high-dose glucocorticoid use (≥10 mg of prednisone daily) increased the rate of infection after adjustment for MTX and TNF inhibitor use (aHR, 3.1).

"Children with JIA had an increased rate of infection compared to children with ADHD," the authors write.